AIDS Healthworkers and Anti-Trafficking Activists – Is There a Conflict?

In the global crisis of violence against women, there is a heated debate about the best way to approach the issues at the intersection of HIV/AIDS and human trafficking. The language used to describe the two differing schools of thought says it all. They are the terms “harm elimination” and “harm reduction.” The former entails the abolishment of sexual slavery, trafficking, and prostitution. The latter involves working to ameliorate the HIV/AIDS crisis in a pre-existing negative situation. Distributing condoms has been at the forefront of that activity. With the Obama Presidency on the horizon, advocates for women’s issues are waiting to see what direction the new players taking over the reins of policy will adopt.

In March of 2008, I interviewed a senior State Department Official who discussed efforts to highlight awareness of the link between sex trafficking and HIV/AIDS. He related statistics showing that as customers seek out increasingly younger girls, the rate of infection for HIV/AIDS for 15-year-olds and under has jumped to over 60%. The official supported a victim-centered approach, with the training of “forensic nurses” to be alert to the HIV/AIDS and sex trafficking connection. He believed there was “a false dichotomy” between the goals of the anti-trafficking activists and the health community.

Yet, several NGOs have been accused of “turning a blind eye to trafficking in brothels.” Anti-trafficking supporters believe the public health perspective reflects the given, “This is going to be happening anyway, so there should be protection.” They pose the rhetorical questions, “In an effort to distribute condoms, is the result a form of “collusion” between public health officials and brothel owners that sends mixed messages? If a child is in a brothel, can the only concern be if this child gets AIDS? Can you fight the spread of HIV/AIDS without on some level contributing to the problem of forced sexual servitude?”

For health workers, the core matter is saving lives through the prevention of spreading AIDS. Anti-trafficking activists are goal-driven to free women and children from conditions where they may be forced to have sex 10 to 30 times per day. Katherine Chon, President and Co-Founder of Polaris Project, sees the “harm reduction” methodology as a narrow policy. She stresses the need for “finding a way to protect the health of women and girls that also address the systemic issues.” She observed, “If you are not asking the right questions, you are not going to get the full picture.”

Taina Ben-Aimé, Executive Director of Equality Now, believes that many in the HIV/AIDS sector don’t “have a gender perspective” and are seeing circumstances strictly as “a medical situation.” She pointed out that distribution of condoms is not foolproof. “Clients are willing to pay a higher price in order to avoid use, and women can be beaten if they insist on use.”

Professor of Women’s Studies at the University of Rhode Island, Donna M. Hughes, PhD., told me, “The sex trade is a form of contemporary slavery. Legal reforms need to create solutions that assist victims and prosecute perpetrators, and are based on the premise that prostitution is a form of violence against women — an extreme form of gender discrimination.” Hughes feels the burden is “on the policy makers of the NGOs and their funders.” She is concerned with HIV/AIDS programs solely targeting disease prevention without pointing to sexual slavery and trafficking as a primary factor in the spread of HIV/AIDS, and sees short-term solutions for the AIDS epidemic as outstripping the examination of how to confront the human rights violations that characterize the slavery of women and children. Hughes suggested NGOs “take their budget, and split it between condom based programming and providing assistance to get out.”

Doctors Without Borders/Médecins Sans Frontières (MSF), was pinpointed in a February 27, 2003 column by Hughes in the Wall Street Journal. “Aiding and Abetting The Slave Trade” questioned why the MSF goal was “not to get the women or girls out of slavery, (but) only to provide HIV/AIDS prevention education.” Hughes asserted, “It’s a sad reality that many seemingly well intentioned NGOs aren’t really about helping victims of abuse.”

Michael R. Goldfarb, Press Officer in the New York City office of MSF, forwarded me a letter from the Asian Wall Street Journal (February 2003) in reply to Hughes’s allegations. Written by the Head of Mission MSF, in Cambodia, Richard Veerman disputed the claim that MSF had turned “its back on the horrible plight of women and young girls forced into commercial sex work.” “Nothing could be further from the truth,” he said. Veerman wrote that MSF was cognizant of groups handling advocacy and rescue for those enslaved in brothels, but was also aware that the women and girls had no access to medical care. Based on that rationale, MSF opened a free clinic in an attempt to “alleviate some of the suffering of the sex workers.” Veerman maintained, “MSF firmly condemns the trafficking of women and children.”

Jerome Oberreit, Director of Operations based in Belgium, explained the two primary concerns of MSF are to provide emergency medical care and to use their medical activities to “witness” the plight of the people it assists. Their foremost responsibility, without judgment, is to the individual. The mandate of “witnessing” is constructed to pass on information to local networks, creating outreach through data. I received, via e-mail, the names of the groups that MSF had passed their information on to.

Director of the Center For Battered Women’s Legal Services at Sanctuary For Families, Dorchen Leiderholdt, believes “when health care workers encounter trafficking victims they have an obligation to take measures to protect those people from abuse.” Holly J. Burkhalter, Vice-President of Governmental Relations for International Justice Mission, sees it differently. “It’s asking health workers to also play the role of law enforcement,” she said. Burkhalter believes those in the health movement do understand the importance of the anti-traffickers concerns, and that the two advocacy interests must work together.

Wenchi Yu Perkins, former Vice President of the Human Rights Program at Vital Voices Global Partnership, does not want to see “harm elimination” and “harm reduction” as mutually exclusive. “Everything comes down to reality…what works and what doesn’t. People are finding the common ground is much bigger than we thought.” Yu Perkins said unequivocally, “There is no such issue as consent for girls under eighteen in brothels. The priority is to get them out.” Young girls, with immature immune systems who experience vaginal bleeding and forced abortions, are more vulnerable to higher rates of HIV.

Currently, the United States Government has taken a stand that they will not give funding or support to any NGO that says prostitution is a form of work. When the Obama team presents their approach to eradicating the crime of modern-day slavery while fighting HIV/AIDS, it will set the tone for the rest of the world. Hopefully, they will be at the forefront of building a global coalition to mobilize a comprehensive approach to the problem.